Children with acquired brain injuries comprise the largest diagnostic group requiring in patient care in specialized rehabilitation hospitals. For accreditation purposes, these hospitals are now required to collect performance measure data for high-volume patient groups. This mandate presents a serious dilemma, since current performance measures in pediatric rehabilitation are inadequate to guide internal improvements or to evaluate comparative performance. After conducting an extensive literature review and consulting experts in the field, in Phase I we designed a 44-item prototype performance instrument. The instrument focuses on three critical content areas for brain-injured children: 1) daily activities, 2) social and behavioral competence, and 3)community readiness skills. In Phase II of the research project, we will conduct a prospective survey of patients in 8 randomly selected facilities, revise the item content, conduct reliability and validity analyses, and develop risk-adjusted benchmarks for expected levels of functioning. The risk adjustment methodology is designed to meet the Joint Commission for the Accreditation of Health Organization's (JCAHO) requirements for approving new instruments. The final product of Phase II will be a marketable performance measurement system for children with acquired brain injury that will meet content and measurement requirements of accreditation and contracting agencies. PROPOSED COMMERCIAL APPLICATIONS: The product of this SBIR project will be a marketable Performance Measurement System for children with Pediatric Brain Injury. As of 1998, all JCAHO accredited hospitals need to contract with a data system to provide comparative data for high-volume patient groups. This Performance Measure meets all the JCAHO requirements and will fill a critical void for in patient pediatric rehabilitation programs. Many acute care children's hospitals may also find this measure helpful in comparing performance of trauma care for children who are directly discharged home.